Objective This study aimed to describe the contemporary aetiology, clinical characteristics and mortality and its predictors in heart failure (HF) in Tanzania. Methods Design; Prospective observational study. Setting; Cardiovascular Center of the Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients ≥18 years of age with HF defined by the Framingham criteria. Main outcome measure All-cause mortality. Results Among 427 included patients, 217 (51%) were females and the mean (SD) age was 55 (17) years. HF aetiologies included hypertension (45%), cardiomyopathy (28%), rheumatic heart disease (RHD) (12%) and ischaemic heart disease (9%). Concurrent atrial fibrillation (AF), clinically significant anaemia, diabetes, tuberculosis and HIV were found in 16%, 12%, 12%, 3% and 2%, respectively, while warfarin was used in 3% of the patients. The mortality rate, 22.4 per 100 person-years over a median follow-up of 7 months, was independently associated with AF, HR 3.4 (95% CI 1.6 to 7.0); in-patient 3.2 (1.5 to 6.8); anaemia 2.3 (1.2 to 4.5); pulmonary hypertension 2.1 (1.1 to 4.2) creatinine clearance 0.98 (0.97 to 1.00) and lack of education 2.3 (1.3 to 4.2). Conclusions In HF in Tanzania, patients are younger than in the developed world, but aetiologies are becoming more similar, with hypertension becoming more and RHD less important. Predictors of mortality possible to intervene against are anaemia, AF and lack of education.

ObjectiveTo determine the pattern of echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania.MethodsPatients known to be HIV positive and with cardiac complaints were prospectively recruited from the Hospital’s care and treatment centre as well as from the medical wards. Clinical assessment, laboratory tests and echocardiography were performed.ResultsA total of 102 patients were recruited from September 2009 to April 2010. The patients’ mean age was 42.4 years and 68.6% were women. The most common diagnosis was pericardial effusion present in 41.2% of the patients. The effusion was large in 5.9% and small in 35.3% of the patients. Hypertensive heart disease was diagnosed in 34.3%, while pulmonary hypertension and dilated cardiomyopathy were present in 12.7 and 9.8%, respectively.ConclusionCardiac abnormalities are common in HIV-infected patients, particularly when they present with symptoms.

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Nucleic acid amplification techniques for the diagnosis of tuberculosis (TB) are rapidly being developed. Scant work, however, has focused on pericardial TB. Using cryopreserved specimens from a prior study of pericarditis, we compared PCR to culture and histopathology for the diagnosis of tuberculous pericarditis in 36 specimens of pericardial fluid and 19 specimens of pericardial tissue from 20 patients. Fluid and tissue were cultured on Lowenstein-Jensen and Middlebrook solid media and in BACTEC radiometric broth. Tissue specimens were stained with hematoxylin-eosin, Ziehl-Neelsen, auramine O, and Kinyoun stains and were examined for granuloma formation and acid-fast bacilli. PCR was performed with both fluid and tissue with IS6110-based primers specific for the Mycobacterium tuberculosis complex by published methods. Sixteen of the 20 patients had tuberculous pericarditis and 4 patients had other diagnoses. TB was correctly diagnosed by culture in 15 (93%) patients, by PCR in 13 (81%) patients, and by histology in 13 of 15 (87%) patients. PCR gave one false-positive result for a patient with Staphylococcus aureus pericarditis. Considering the individual specimens as the unit of analysis, M. tuberculosis was identified by culture in 30 of 43 specimens (70%) from patients with tuberculous pericarditis and by PCR in 14 of 28 specimens (50%) from patients with tuberculous pericarditis (P > 0.15). The sensitivity of PCR was higher with tissue specimens (12 of 15; 80%) than with fluid specimens (2 of 13; 15%; P = 0.002). In conclusion, the overall accuracy of PCR approached the results of conventional methods, although PCR was much faster. Therefore, PCR merits further development in this regard. The sensitivity of PCR with pericardial fluid was poor, and false-positive results with PCR remain a concern.

Objective-To determine the prevalence, correlates and prognostic implications of anaemia and iron deficiency (ID) in patients with heart failure (HF) in Tanzania.Method-This was a cross-sectional and prospective observational study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were ≥18 years of age, with HF defined according to the Framingham criteria. The primary outcome was anaemia and the secondary outcome was a composite of hospitalisation for HF or all-cause mortality.Results-A total of 401 HF patients (median age 56 years, IQR 41-67 years; women 51%) were included. The prevalence of anaemia was 57%. The overall prevalence of ID was 49% distributed as 69% versus 21% in subjects with and without anaemia (p<0.001). Normocytic anaemia was seen in 18% of the patients while none had macrocytic anaemia. The risk of having anaemia was positively associated with residency outside Dar es Salaam (OR 1.72 (95% CI 1.02 to 2.89); p=0.038), atrial fibrillation (4.12 (1.60 to 10.61); p=0.003), LVEF <45% (2.70 (1.57 to 4.67); p<0.001) and negatively (ORs per unit decrease) with creatinine clearance (0.98 (0.97 to 0.99);Correspondence to: Dr Abel Makubi, Muhimbili University of Health and Allied, Sciences, School of Medicine, PO BOX 65001, Dar es Salaam, Tanzania; makubi55@gmail.com. Contributors All authors have made significant contributions to the design, execution, analysis and writing of this study and will share responsibility for the published material. Competing interests None. Ethics approval TaHeF was approved by the ethical review board of the Muhimbili University of Health and Allied Sciences (MUHAS). All patients provided written informed consent.Provenance and peer review Not commissioned; externally peer reviewed. Data sharing statementPatient-level data, full data set and statistical codes are available from the corresponding author. Informed consent for data sharing was not obtained, but the presented data are anonymised and risk of identification is low. Conclusions-ID anaemia was common in Tanzanian patients with HF and was independently associated with the risk for hospitalisation or death. Europe PMC Funders Group

Cardiovascular diseases, including heart failure are a known complication of Human Immunodeficiency Virus (HIV) infection globally. The objective of this study was to describe factors associated with, and echocardiographic findings of heart failure among HIV infected patients at a tertiary health care facility in Dar es Salaam, Tanzania. Clinical, laboratory and echocardiographic assessment was performed in all HIV-infected patients presenting with cardiac complaints at the medical department, Muhimbili National Hospital between September 2009 and April 2010. HF was diagnosed clinically and confirmed by echocardiography. Of the 102 HIV-infected patients with cardiac complaints 50 (49%) were in HF. Commonest causes of HF were hypertensive heart disease, pulmonary hypertension and dilated cardiomyopathy. In multivariate analysis male gender (OR 4.03), low education (OR 4.91), previous history of tuberculosis (OR 3.01), and low haemoglobin (OR 0.83), were independently associated with the diagnosis of HF (p<0.05 for all). In conclusion, heart failure is common in HIV-infected patients with cardiac complaints, and is associated with both modifiable and non-modifiable factors.

Background-Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden.Methods-A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after * Corresponding author at: Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden. makubi55@gmail.com (A. Makubi). ✩ The study conducted at Jakaya Kikwete Cardiac Institute, Muhimbili National Hospital in Dar es Salaam Tanzania and at the Swedish Heart failure registry, in Stockholm Sweden. 1 These authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. 2 These authors take responsibility for data and statistical analysis, interpretation of data and critical revision of manuscript. 3 These authors take responsibility for concept and design, interpretation of data, critical review of manuscript.Supplementary data to this article can be found online at http://dx.doi.org/10.1016/j.ijcard.2016.06.239. Declaration of interestAM was supported by MUHAS-SIDA through capacity strengthening program, Germany exchange program for education (DAAD) and partly from Karolinska Institutet through the Department of Medicine Solna. UD has no disclosures related to the present work. Unrelated disclosures are: research grants from AstraZeneca, and consulting or speaker's honoraria from Novartis. LHL has no disclosures directly related to the present work. Unrelated disclosures are: research grants from AstraZeneca, Boston Scientific; consulting or speaker's honoraria from Novartis, AstraZeneca, Bayer, St Jude, Medtronic, ViforPharma. Conclusions-Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis. Europe PMC Funders Group

Enlarged LA is common among asymptomatic Tanzanian diabetic patients, and particularly associated with LV diastolic dysfunction in type 2, and with cardiomyopathy and lower systolic function in type 1 diabetic patients.